They typically say you can have sex about six weeks after delivering a baby. That doesn’t mean you want to have sex, it just means your body will not explode if you have sex at this point. Let’s cut to the chase – sex can suck after having a baby. It’s not just that you still look pregnant, your nipples are leaking and you’re freakin’ tired, it’s that sex can actually hurt.

Oh, let me count the ways. Really. I’m counting the reasons sex hurts after having a baby and I can think of seven of them:

1. The extra stitch. If you had a vaginal birth and tore naturally or the doctor cut the perineum (the space between the vagina and the anus) and you needed stitches and you have a really, really old-fashioned doctor…it’s very possible you got “the Husband Stitch”. This is an extra, unnecessary stitch at the perineum that is supposed to make your vaginal opening smaller. Sometimes women ask for this, most of the time they don’t. The doctors take it upon themselves to do this because they think they are doing you a favor – for your sex life. How thoughtful, right? Some women don’t even know they got this, all they know is that their vagina feels smaller and they have “no idea why”. This can cause pain with sex. It’s not that the stitch doesn’t heal correctly, it’s that your vagina is smaller. This opens up a whole can of worms that this post isn’t going into.

2.No extra stitches. Just the ones you needed. So, if you needed stitches and had an ethical physician, then you got exactly what you needed. These stitches will heal well, but sometimes they can leave you with scar tissue at the perineum. This can be really problematic with sex because scar tissue makes everything tighter and more sensitive. It can make your muscles in your vagina way too tense when they are supposed to be relaxing.

3. Natural tearing. Same thing as #2. Even with natural tearing you are going to have some scar tissue. If you don’t work through this scar tissue and massage it and knead it (yes, like bread) then it can create painful sex.

4. Breastfeeding and dryness and low libido. Breastfeeding can lower your natural hormone levels inside and outside the vagina making sex dry and lowering your sex drive. This is a snowball problem. No, not that kind of snowball problem (you are nasty!). But, if you don’t have sex drive, your vagina will not get wet. When your vagina doesn’t get wet enough, there is friction and this feels like sandpaper and tearing. You must, must, must use some sort of lubricant. I think that the most gentle lubricants for painful sex are coconut oil and olive oil or something water-based like Slippery Stuff. I really hate KY and Astroglide. They do great marketing, but they’re really not made for the sensitive vagina.

5. Having sex and worrying about the baby waking or being in the room. So, the really cool thing about the pelvic floor (the support muscles in the pelvis that keep up all your organs and span from all around your vagina and clitoris to all around your anus and from one hip to the other, basically) is that they respond to what we’re thinking. They are mind readers. Your pelvic floor is a mind reader. That is amazing, right? When you are scared, nervous, anxious or uncomfortable, your pelvic floor muscles will automatically respond and tense up. This makes your vagina and your anus smaller – in that moment. It’s a really primitive response. It’s your body’s old-fashioned way of trying to protect your reproductive parts so that you will survive and continue to make more humans. It’s fascinating! I really stress that if you have pain with sex, you really have to have sex when the timing is right for your mind. When your brain is more relaxed, your vagina is more relaxed.

6. C-section. Just like the stitch scenario, c-sections leave scars. If you don’t work this scar, the scar tissue will grown down into the layers beneath it and really create problems. This can cause bladder problems, bowel problems and…painful sex. No one really enforces how important it is to work that scar. And if you’ve had repeat c-sections – holy moly cannoli! – work the scar! You might not have problems now, but if you don’t work that scar, you will have problems later.

7. Attempted vaginal delivery and a c-section. You’re fucked. No, not really, I just thought that was funny. But, it’s not really funny because both your pelvic floor and abdomen have been through Hell and back. You might have perineal tearing and a c-section scar. You’ve got a lot of reasons why sex could hurt, so work the scars in both places to minimize and eliminate the problem.

So, if you’ve found yourself with any of the Seven Unsexy Sins, there is good help available. Pelvic floor physical therapy is a specialty of physical therapy that is completely devoted to pelvic issues – whether it’s pain or incontinence or constipation or something quite scandalous. In many countries (the United States not included) pelvic floor physical therapy is a standard aspect of care after delivering a child.

Pelvic floor physical therapy is intimate and it’s invasive, but it’s really not as uncomfortable as people expect it to be. A pelvic floor physical therapist will do an exam on your pelvic floor muscles, determine what your exact reason for painful sex is, then they will teach you things that you can do at home and they will do “hands on” work inside the vagina and outside the vagina. If you have an unsexy sin, checking out a Pelvic floor physical therapist is worth a shot. You deserve to be sexy again.